Best Practices for Mechanical Circulatory Support with Impella for Acute Myocardial Infarction Cardiogenic Shock and Selected Structural Interventions

Abstract

The introduction of angioplasty to treat acute myocardial infarction (MI) demonstrated a substantial improvement in survival in patients without shock; however, mortality in patients with cardiogenic shock remains high. In the last 30 years, there has been no improvement in survival in acute myocardial infarction cardiogenic shock (AMICS) patients. Reperfusion therapy has improved survival, but only to 50%, as no other therapies have been employed until recently. Now, circulatory support agents like the Impella catheter allow rapid left ventricular support for patients with acute myocardial infarction in cardiogenic shock. The Detroit Cardiogenic Shock Initiative and the National Cardiogenic Shock Initiative have shown substantial improvement in survival with patients with acute MI cardiogenic shock dark treated with Impella mechanical circulatory support. These studies must be confirmed by randomized trials, but before optimal use of mechanical circulatory support is required, to optimize benefits, best practices need to be determined. This will be the main topic of this chapter. In addition, we will review the role of Impella in different structural interventions.